Identifying and evaluating novel treatment targets for the development of evidence-based interventions for [FND], 2021, Fobian & Szaflarski

Highlights

• Recent evidence indicates targeting mood may have limited to no effect on FND.
• Future research should identify and evaluate novel treatment targets.
• Mechanisms have been identified that warrant additional investigation as targets.
• Studies should assess if change in symptoms are associated with change in targets.
• This will allow the translation of neuroscience outcomes into new FND treatments.

Abstract

Historically, functional neurological disorder (FND) has been described in psychodynamic terms as the physical manifestation of psychological distress. It is often explained to patients and caregivers as the result of anxiety, stress, trauma or other psychiatric comorbidities. However, recent evidence indicates that targeting mood and stress is not equivalent to the treatment of FND and may have limited to no effect on FND symptoms. Given the few randomized controlled trials for FND treatments and the limited evidence of mood and stress as effective treatment targets, the identification and evaluation of novel treatment targets or mediators is an area of great opportunity and should be the focus of future research. Identifying and targeting modifiable disease mechanisms directly as opposed to only treating psychiatric comorbidities may result in greater efficacy in treating FND symptoms, better patient outcomes and lower healthcare costs. Several novel mechanisms have been identified that warrant additional investigation as potential treatment targets including abnormal attentional focus on the affected area, beliefs and expectations about illness, impairments in habituation, and decreased sense of control over actions. Future intervention studies should take a mechanism-based approach and utilize valid and reliable measures or specific biomarkers to determine whether improvements in FND symptoms are associated with changes in the treatment targets. This transdiagnostic approach will allow researchers to translate the novel mechanistic outcomes emerging from neurophysiological and neuroscience studies into new or improved evidence-based approaches to FND treatment and prevention.

Open access, https://www.sciencedirect.com/science/article/pii/S2589986421000538

 

Should I laugh or should I cry?

 

Schrodinger's medicine: it's both complete and effective, but also everything is still to be done and nothing's actually effective, because "developing" treatments is both the end and the mean, basically like Dungeons & Dragons players who find the game boring and just want to roll dices to build powerful characters they will never play.

Also somehow the "novel" approaches are the exact same as the old approaches, recycled every few decade or so. At this point it's frankly not even fair to blame these people, they are showered with unlimited funding and support, it's that they are allowed to continue to operate despite being caught in a time loop of mediocrity that is wrong. This is medicine without science, humanity or oversight, it serves absolutely no purpose other than continuing to do the same thing in a loop, consequences be damned, they never face any so they don't even have to care.

 

I agree. At first I was thinking yay, but then, I realized this is still the same old thing. Sigh.